Identification of Normal Fornix Depth Dataset Generated with a Validated Fornix Meter in Healthy Turkish Population.

PURPOSE: To provide an age and sex-classified reference dataset for normal fornix depth by measuring the lower and upper conjunctival fornix depth (FD) in healthy volunteers. METHODS: An epidemiological, prospective, cross-sectional study evaluates conjunctival FDs in 301 healthy Turkish volunteers aged 20-83. Fornix measurements were made using a validated fornix depth measurer (FDM). RESULTS: The mean age was 49.2 ± 19 in males and 48.6 ± 16.2 in females. The mean upper and lower conjunctival FDs were 15.9 (12-21) mm and 10.1 (6-13) mm, respectively. The mean upper and lower FDs were 15.4 (13-20) mm and 9.7 (6-13) mm in females, and 16.3 (12-21) mm and 10.5 (8-13) mm in males, respectively. . CONCLUSION: When the normative dataset created in healthy Turkish volunteers, it was observed that both the upper and lower FDs were shallower in females and that they gradually became shallower with age. Accordingly, when an evaluation for conjunctival pathology is to be made, the expected normal FD value for both age and sex should be considered.

Precision of limbal ischemia evaluation in ocular chemical injuries with anterior segment optical coherence tomography angiography.

PURPOSE: To evaluate the limbal ischemia objectively in ocular surface chemical injuries by using anterior segment optical coherence tomography angiography (AS-OCTA). METHODS: In this cross-sectional study, acute ocular surface chemical injury patients with less than 1 week injury history were enrolled. Demographic data of the patients were noted, and detailed ophthalmological examination with Dua classification was performed. AS photographs and AS-OCTA images were obtained and used for the assessment of limbal ischemia. To visualize the limbal vasculature, the device was focused manually to get a sharp image for all 4 quadrants of the limbus. The absence of vasculature was regarded as "ischemia," and the amount of the ischemia was defined in clock hours. The limbal ischemia detected in clinical evaluation with biomicroscopy was compared with the AS-OCTA detected ischemia amount to make a conclusion for the correlation. RESULTS: Nineteen eyes of 18 patients with acute ocular surface chemical injury were enrolled to the study (2 female, 16 male). The mean age was 35.1 ± 10 (18-55), and the mean best corrected visual acuity was 0.75 ± 1 (0.1-3.1) LogMAR. The causative agents were acid in 6 and alkaline in 12 patients. Limbal ischemia detected by using AS-OCTA was greater ((5.8 ± 2.6 (2-10) clock hours) than that detected in biomicroscopy (4.8 ± 2.4 (2-12) clock hours). The difference was statistically significant (p < 0.0005). CONCLUSION: AS-OCTA has a significant importance on limbal vascularity visualization; therefore, its use for more objective and sensitive evaluation of limbal ischemia in ocular surface chemical injuries seems to have a crucial impact. AS-OCTA images may reveal the extension of limbal ischemia more precisely than clinical evaluation with biomicroscopy. However, future studies with higher number of patients are needed to come to a specific conclusion.

Retinal detachment in a child with Frank-ter Haar syndrome.

BACKGROUND: To present a rare case of ocular involvement in a child with Frank-ter Haar syndrome (FTHS) presenting retinal detachment. MATERIALS AND METHODS: Detailed ophthalmological evaluation including examination under general anesthesia, ocular ultrasound, and visual evoked potential testing was completed. Photographic documentation of the physical findings was obtained. RESULTS: A 3-year-old female patient with FTHS was referred to evaluate for possible ophthalmic involvement. The patient presented with the classical dysmorphic abnormalities of the syndrome. Ophthalmologic evaluation revealed a high, against-the-rule corneal astigmatism in the right eye. In the left eye, the red reflex was absent with a suspicious membrane behind the lens, and a sensory exotropia was present. Ultrasonography confirmed retinal detachment with no history of previous trauma. Due to poor visual evoked potentials, no surgery was planned. Astigmatic refractive error was corrected with routine follow-up. CONCLUSIONS: FTHS is associated with multiple ocular involvement such as megalocornea, congenital glaucoma, or colobomas. This case report is the first to describe a high, against-the-rule astigmatism and retinal detachment in a female child with FTHS and demonstrates that an early and detailed ophthalmological examination is essential for these patients.

Palliative Efficacy of Intrastromal Amniotic Membrane Procedure in Symptomatic Bullous Keratopathy Patients.

Objectives: To evaluate the palliative efficacy of the intrastromal human amniotic membrane (hAM) surgery technique in patients with symptomatic bullous keratopathy and limited visual potential. Materials and Methods: The study was carried out retrospectively by reviewing the medical data of 10 patients with poor visual prognosis who underwent intrastromal hAM surgery due to bullous keratopathy-related severe pain. Visual acuity, surgical indication, epithelization time, preoperative and postoperative pain scores, as well as anterior segment optical coherence tomography images and anterior segment photographs were obtained from the medical records. Results: Ten patients (6 females/4 males) were included in the study. Nine patients underwent surgery for pseudophakic bullous keratopathy and glaucoma, and 1 patient due to graft failure and glaucoma. The mean time for corneal epithelization was 27.10±13.05 days (range, 10-50), while the mean follow-up time was 37.5±1.6 months (range, 36-39.2). Subjective pain score improved in all patients after surgery. Suture-induced keratitis occurred during follow-up in one patient and was controlled with medical treatment. Conclusion: Intrastromal amniotic membrane surgery may be an alternative to keratoplasty for pain palliation in patients with limited visual prognosis after corneal transplantation when donor tissue is scarce. With this method, hAM remains on the ocular surface longer, and superficial stromal excision is believed to provide a more regular ocular surface and extend the asymptomatic period.

Evaluation of Choroidal Vascular Index in Amblyopic Patients.

Objectives: To compare subfoveal choroidal thickness (SFCT) and choroidal vascular index (CVI) in patients with hyperopic refractive and strabismic amblyopia and healthy subjects. Materials and Methods: The study included 17 patients with strabismic amblyopia (Group 1), 29 patients with hyperopic refractive amblyopia (Group 2), and 16 eyes of 16 healthy volunteers (Group 3). Best corrected visual acuity was noted in all patients and volunteers. In addition to detailed anterior and posterior segment examinations, macular images were obtained by enhanced-depth imaging mode of optical coherence tomography (OCT). SFCT measurements were made from these images and CVI was calculated using the Image J program. Results: No significant difference was found between the groups in terms of age, gender, and intraocular pressure (p=0.27, 0.64, and 0.85, respectively). Mean BCVAs in Group 1 were 0.57±0.16 (0.3-0.8) in the amblyopic eyes, 0.94±0.08 (0.8-1.0) in the fellow eyes, and in Group 2 were 0.61±0.17 (0.2-0.8) in amblyopic eyes, 0.92±0.1 (0.8-1.0) in fellow eyes. BCVA in Group 3 was 1.0±0 (1.0-1.0). Mean SFCT of the amblyopic eyes in Groups 1 and 2 was 341.50±60.4 (277-481) and 370.06±65.3 (247-462), respectively, and in the healthy eyes of Groups 1 and 2 and Group 3 was 321.92±68.26 (251-440), 330.35±74.00 (194-502), and 327.62±40.79 (238-385), respectively. SFCT was significantly greater in the amblyopic eyes of Group 2 compared to Group 3 (p=0.01). Mean CVI was 0.681±0.032 (0.642-0.736) in the amblyopic eyes and 0.685±0.054 (0.587-0.788) in the fellow eyes of Group 1 patients; 0.664±0.033 (0.592-0.719) in the amblyopic eye and 0.707±0.039 (0.625-0.779) in the fellow eye in Group 2 patients; and 0.689±0.031 (0.612-0.748) in Group 3 patients. CVI was significantly lower in the amblyopic eyes of Group 2 compared with fellow eyes (p=0.02) and Group 3 (p=0.025). Conclusion: Morphological changes may be seen in the choroid in amblyopic eyes. We observed that the choroidal stromal component is increased in hyperopic amblyopic patients especially.

Sheath-Preserving Complete Optic Nerve Avulsion Following Closed-Globe Injury: A Case Report.

A 29-year-old man presented with a sudden loss of vision after a closed-globe injury. At presentation, he had no light perception in the right eye and the right pupil was dilated and nonreactive to light. On ophthalmological examination, the area of the optic nerve head was excavated, suggesting optic nerve avulsion. Magnetic resonance imaging scan showed optic nerve avulsion without rupture of the optic nerve sheath. Four months after the injury, the patient's visual acuity remained unchanged. Gliosis developed at the avulsion site. Closed-globe injuries may cause severe posterior injury even if there is no anterior damage in the eye. To prevent unnecessary treatment, trauma patients should be examined carefully appropriate imaging to confirm the diagnosis.

Use of Systemic Mycophenolate Mofetil Therapy in Ocular Surface Inflammatory Pathologies at the Initiative and Responsibility of the Ophthalmologist.

PURPOSE: The purpose of the study was to evaluate the efficacy and safety of systemic mycophenolate mofetil (MMF) treatment in ocular surface inflammatory diseases. METHODS: For this retrospective study, patients who were treated with systemic MMF for ocular surface inflammatory diseases between March 2020 and March 2022 were evaluated. Apart from demographic data, examination notes including MMF treatment indication and systemic side effect interrogation and routine laboratory examinations during drug treatment were extracted from the patient records. Detailed staging scores were performed according to the diagnosis including Foster and Mondino for ocular mucous membrane pemphigoid (MMP) and limbal stem cell deficiency scoring for limbal transplantation. For thorough evaluation, anterior segment pictures were used. RESULTS: Fourteen patients were enrolled to the study, with a mean age of 58 ± 12. MMP (6, 42.8%) and limbal allograft transplantation (6, 42.8%) constituted the main indications for the MMF treatment, followed by keratitis-ichthyosis-deafness (KID) syndrome (1, 7.2%) and Mooren's ulcer (1, 7.2%). Five of six patients with MMP regressed according to both staging systems. Only one remained stable which was evaluated as Stage 3. Furthermore, while all limbal transplant groups (6) stabilized and showed regression according to the individualized limbal stem cell deficiency staging system with no rejection during follow-up. Furthermore, patients with Mooren's ulcer and KID syndrome showed control of the inflammation and stabilization after MMF treatment. No significant systemic side effects apart from constipation and nausea (3) were observed in patients whose routine laboratory tests were stable throughout the follow-up. CONCLUSION: MMF has the potential to be a valuable and safe systemic agent of first choice in the control of ocular surface inflammatory disorders, especially when topical treatment is not effective. With such studies, it is predicted that MMF may reach wider usage areas with the increase in its effectiveness and safety in its use for ocular surface inflammatory pathologies.

Multimodal Imaging of Isolated Foveal Hypoplasia: A Case Report.

Fovea hipoplazisi, normal foveanin gelismemesi ile karakterizedir. Izole veya baska oküler durumlarda sekonder olarak gelisebilmektedir. Optik koherens tomografi (OKT), floresein anjiyografi, fundus otofloresans ve OKT anjiyografi tanida kullanilabilir. Bu olgu sunumunda multimodal görüntüleme ile tani konulan, foveal hipoplazili bir hastayi sunmaktayiz.